Background: With the advent of intracytoplasmic sperm injection (ICSI), fertilization and pregnancy have been reported in complete asthenozoospermia. The major problem with the use of immotile sperm for ICSI has been differentiating between live and dead sperm. We successfully selected live sperms with the hypoosmotic swelling test, and a twin pregnancy resulted after intracytoplasmic injection of completely immotile sperm.
Case: A 32-year-old woman and her 36-year-old husband had had primary infertility for four years. Evaluation of the couple showed complete asthenozoospermia of the husband. Ovulation in the wife was successfully stimulated with clomiphene citrate, follicle-stimulating hormone and human menopausal gonadotropin. We selected the viable sperm with the hypoosmotic swelling test. ICSI was then performed. After assisted hatching, we transferred four embryos on the third day after oocyte retrieval. Intrauterine twin pregnancy was confirmed by ultrasonography four weeks later. The healthy infants, free of anomalies, were born on the 36th gestational week.
Conclusion: The hypoosmotic swelling test is a simple method of selecting immotile and viable sperm for use in ICSI.